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Mysteries of the Medicine Cabinet-How and when to properly dispose of old medication

Medicine cabinets tend to bring out the packrat in most of us. Once we’ve gone to the trouble and expense of a doctor’s appointment or a trip to the pharmacy, we find it hard to part with anything remaining in the bottle when we feel better.

Is there anything wrong with keeping those three Hydrocodone tablets left over from your root canal last year? How about the cough syrup your daughter’s pediatrician prescribed this winter? Even if you don’t need it, how should you dispose of it? Dealing with it seems like so much trouble, we’d rather just close the door and forget it.

Location, Location, Location

Real estate isn’t the only business where location matters. Whether you’re dealing with prescription or over-the-counter medication, storage location is important. According to Heidi Kallivayalil, PharmD., Ambulatory and In-Hospital Practitioner, one of the worst places to store medications is the bathroom medicine cabinet. The steam and humidity from the sink and shower produce moisture that can seep in and cause drugs to degrade.

Unless special storage instructions are given, medications should be kept in a cool, dry place. Consider using the linen closet or a kitchen cabinet that’s located away from the stove and sink. You should also avoid storing medications in the refrigerator unless instructions specifically say so. Refrigerated air is too damp for most medications. If refrigeration is required, placing the bottle in an opaque plastic container on a high shelf helps to keep it out-of-sight.

A cabinet or box with a lock on it is a good idea for homes that have young children or teenagers. According to the Partnership for a Drug-Free America, 64 percent of kids between the age of 12 and 17 who have abused pain relievers say they got them from friends or relatives, typically without their knowledge. Even over-the-counter and non-narcotic medication can be dangerous when mixed or in the hands of children. Locking up medication doesn’t mean we don’t trust our kids; it’s just one more way of keeping them safe.

Also, be sure to store medication in the original container with the name and expiration date on the label. “Some medication can be affected by light,” says Kallivayalil, “that’s why prescription medication comes in amber-colored bottles.” Resist the urge to transfer pills to a smaller bottle or to combine even the same medication into one bottle. If you end up with multiple medications in the same container, they can be difficult to identify and risky to take.

Ann Greene, a pharmacist at O’Steen’s Pharmacy in Jacksonville, says she is occasionally asked to play detective by identifying medication that has been transferred from a prescription bottle to a daily or weekly pill reminder case. “Usually, it’s a family member that transfers the pills,” says Greene. “When you’re dealing with generic medications, the color is sometimes changed. Clients will be used to taking a pink pill and then the color is changed to orange. We note this on the bottle, but if a pill has been transferred to another container, it can cause confusion. I have seen cases where it leads to double dosing. The client actually takes the pill in the reminder case and also the familiar pink pill from the bottle.”

Take or Toss?

Most of us have ended up with small amounts of medication left over from various illnesses. When this happens, it’s a good idea to get rid of it. Although most expired drugs aren’t necessarily harmful, they can lose their potency. It may be tempting to hang on to them to avoid a future trip to the doctor, but there are reasons why you shouldn’t.

Unless medication is prescribed on an as needed basis (which is common for pain killers and other medications needed intermittently) it’s important to take every dose. Not doing so can lead to complications. For instance, small doses of antibiotics may not destroy an infection, and eventually could cause bacteria to develop a resistance to that particular antibiotic, making it difficult to treat in the future. Dosage amounts are different for every medication, so it’s important to follow instructions closely.

Parents occasionally give medication prescribed for one child to another child. Sharing may be a good thing most of the time, but in this case it isn’t recommended. Even if children have the same illness, that doesn’t necessarily mean they should be given the same medication or the same dosage. Drug allergies are common, particularly with antibiotics. It’s best to let your physician determine what medication is appropriate for each illness.

Is This Still Good?

The shelf-life is the period of time the manufacturer has determined to be the safest and most effective for that particular medication. All medications should have an expiration date. Most prescription bottles have the date typed clearly on the label. Over-the-counter medications sometimes have the date stamped on the outside box. If you remove the tube or bottle from the box, check for a date. If you don’t see one, be sure to write the expiration date on the container with a permanent marker.

Many prescription medications expire one year from the date they were filled, but don’t just assume. According to Kallivayalil, some medications expire more quickly than others. Liquid medications often have a shorter shelf-life, some as little as 14 days.

Even supplies like adhesive bandages and hydrogen peroxide come with expiration dates. For example, Vaseline® recommends keeping their products, like petroleum jelly and moisturizers, at room temperature for up to two years.

A Closer Look

Always make sure to examine medication before taking it. Even if you’ve used the same prescription every night for the past decade, it pays to be alert. Take time to double check the name and appearance of the medication.

Be aware of anything that doesn’t look right. Capsules that are stuck together or pills that have changed color could indicate moisture has seeped into the container and they should be tossed. The same goes for any medication that is crumbled, has spots or has changed in consistency or appearance.

Leaving medication in the car can also lead to problems, especially during the summer months in Florida. “Most medication should be kept at room temperature and is stable up to about 78 degrees,” says Greene. Higher temperatures can be damaging, “If capsules are left in the glove compartment on a warm day, temperatures can climb high enough to actually melt them.” When that happens, most pharmacies are willing to exchange the damaged medication but only at the patient’s expense.

Safe Disposal

Pouring old medications down the drain or flushing them in the toilet used to be an acceptable way to dispose of them. In Florida, the Department of Environmental Protection and the Department of Health both advise against it. What’s the big deal? This method of disposal leads to a risk of contamination of Florida’s drinking water and water bodies. Most wastewater treatment systems aren’t equipped to remove medications, which means they will eventually make their way into water sources. It’s unlikely such small traces are enough to be harmful to humans, but the Florida DEP says research has shown there can be an effect on aquatic organisms like fish and frogs.

According to Eulinda Smith, spokesperson for the Florida DEP, there are a number of steps you can take to protect both humans and animals from risk when disposing of medications:

Pills and Capsules

A)Keep medication in its original container with the prescription name. This helps to identify it if it is accidentally ingested by a person or animal.
B)Mark out your name and the prescription number before tossing.
C)Add a small amount of liquid such as water or soda to the bottle to help dissolve medication.
D)Tape the lid securely with duct tape or packing tape.
E)Place the taped bottle inside a coffee can or opaque plastic container like an empty laundry detergent bottle. Tape the lid on the outer container, too.
F)Hide the container in the trash…don’t recycle it.

Liquid medications

A)Add cat litter or dirt to the remaining liquid. Anything that makes the liquid less palatable to animals or humans, such as cayenne pepper, could also be used.
B)Follow the same instructions for taping the lid and placing in an outer container.

If you come across other non-medication items while cleaning out your medicine cabinet, don’t just assume it’s okay to toss them in your regular trash either. Certain items such as thermometers also have specific disposal requirements. Mercury filled thermometers should be taken to a hazardous waste facility and digital thermometers containing a button cell battery should be recycled in the same manner as other batteries.

Once you’ve organized your home medications and supplies, an occasional check is all that’s necessary. Dispose of left-over prescription medications as soon as you’re finished with them, and periodically check the expiration date on over-the-counter medicines. Maintaining proper storage and disposal procedures will help to keep your family and the environment safe.

About the Author

Medicine Cabinets tend to bring out the packrat in most of us. Once we’ve gone to the trouble and expense of a doctor’s appointment or a trip to the pharmacy, we find it hard to part with anything remaining in the bottle when we feel better. For details visit http://www.healthsourcemag.com

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